Lucy could sleep really well, which was a surprise blessing. Her waking life, on the other hand, was so constrained it was like a prison. Lucy had constant daily pain in her knees, ankles, feet, neck, wrists and lower back. She was 35 years old. She couldn’t go out to dinner with friends because the pain of sitting would be too much for her lower back. She hadn’t exercised for more than five years because her feet would hurt too much. She never made it through a month of work without needing at least two sick days because of severe headaches. Her gym sessions were limited to the sort of intensity and variety you would expect from an 80-year-old stroke victim, but she bravely continued with them twice a week under supervision. From my perspective,  most concerning of all was the fact that she felt perpetually daunted by flights of stairs; and any walk further than two blocks. 

The Dunedin Study, which is a globally significant piece of longevity research, discovered that landing on your 35th birthday with a fear of stairs and a slowing gait gives you a predictably shorter life expectancy. The impact of Lucy’s pain met the criteria for a full-blown disability, with the expected long-term impacts of chronic disease. Yet, like so many chronic pain sufferers, she had no diagnosable medical conditions whatsoever.

An endless line of specialists had confirmed that Lucy’s lab tests and scans were completely normal and had been for years. There was categorically nothing wrong with her medically. And yet, five years from the onset of her symptoms, she was living with more disability than many sufferers of degenerative conditions like multiple sclerosis are at the same milestones.

On a physical level, Lucy was fairly unremarkable too. She was moderately overweight, had average height, had somewhat flat feet and had a lack of muscle tone in her upper back and gluteal muscles. All of which are incredibly common issues in pain-free individuals. She basically had the same common notes that apply to countless millions of pain-free office workers.

There was, however, one unusual physical finding.

She had incredibly intense pain points throughout her neck, gluteal muscles, lower back muscles, and feet. These ‘myofascial trigger points'(the painful areas in muscle that we all feel during deep tissue massage) are common to all pain sufferers. But Lucy’s were so sensitive that she could barely cope with having them receiving the lightest touch.  All these painful areas very much stood out as being unusually sensitive to the touch, to the extent that meeting someone with soft tissues that sensitive is quite a rare event – even for someone who treats pain all day, every day. 

Lucy had very, very sensitive soft tissues. And there was another big difference between Lucy and virtually everyone else with pain. She’s totally untreatable.

Lucy had tried multiple chiropractors, acupuncture, osteopathy, countless pain medications, various physiotherapists, neurologists, orthopaedic surgeons, endocrinologists, gynaecologists, rolfing experts, deep tissue massage, radial shockwave therapy, focused shockwave therapy, LLLT laser therapy, cortisone shots, botox injections, somatic experiencing, nerve blocks, custom insoles, gym work, trigger point release, brainwave entrainment, EMDR therapy, trauma release exercises, counselling, pilates, yoga, multiple elimination diets and water fasting. None of which put the slightest dent in her pain.

For a bit of healthcare context that many would not be aware of. If you patiently and methodically direct that many healthcare solutions at 1000 chronic pain sufferers, more than 999 of them will experience meaningful reductions in their pain and disability scores. The real reason so many people get stuck with chronic pain is not that it’s untreatable. It is because so few have access to the right healthcare, or they do have access but are unable to follow through with the necessary effort. So Lucy was in a tiny percentile of unresponsive pain sufferers.

I personally had a hand in providing a substantial number of these therapies for Lucy myself, and it was soul-destroying work. Zero improvements. She would respond normally to treatment at first and often felt a lot better for a handful of days after treatment. But the pain always came back as strongly as ever, as if the effects were repeatedly being reversed. 

If all else was equal, we might file Lucy under medical mysteries. But all else was not equal. In fact, it was not even close to being equal compared to the average pain sufferer.

Despite being medically and physically normal in so many ways, Lucy was far from okay, and not just because of the pain. Yet, to understand just how ‘not okay’ Lucy was, you had to take the time to talk to her.

Outside of the stubbornness of her pain itself, the most unusual thing about Lucy was her level of unhappiness. She was living somewhere that she found so culturally different from her country of origin that she felt like an outcast. This meant she had struggled to meet friends and missed her family all the time. She had chosen a career path that she didn’t like, working with people she didn’t get along with, but it was too well-paid to walk away from. Growing up, she had been a very sensitive child with one very critical parent, which she still hadn’t come to terms with. She had not been able to meet a partner as she found the dating scene in NZ to be difficult. This created a fear of never having children, and she felt time was running out for her. And all this fuelled a food addiction she had developed from an early age as a coping mechanism. The weight gain and addiction caused her to feel a good deal of self-loathing. And on top of all that, although we never discussed it, she bore many common signs of someone who has been abused at some point in their life. Hopefully, my instinct about that was wrong.

If you treat chronic pain, you meet a lot of very unhappy people. But it is rare to meet someone who doesn’t seem to have a single thing in their life that is going well. Yet Lucy qualified. Mentally, emotionally and spiritually, she was in very bad shape. Socially she was in bad shape. Romantically she was in bad shape. Professionally she was in bad shape. Culturally she was in bad shape. Physically she was certainly in bad shape. And on top of all, she really missed her mum. 

And it just so happened that she also had the most untreatable pain you are ever likely to meet. The unhappiest patient one is ever likely to meet. And the most intractable pain one is ever likely to meet.  

The connection between mental health, trauma and chronic pain has been established beyond any scientific doubt whatsoever. This connection is one of the very few issues that all genuine pain experts across all the relevant fields of healthcare can agree upon. 

Dave was a Vietnam War veteran. He had been drafted to the war effort as part of New Zealand’s questionable contribution to the carnage. He went from the wide, safe open spaces of a Canterbury farm in NZ;  to deep and utterly horrifying jungle warfare in a matter of months, at 19 years of age. We can safely agree that more or less qualifies him for having been a child soldier. And his trauma resume certainly reads like that of an average child soldier.

Dave is very open about his experiences, although I imagine that, like many war veterans, there are some he doesn’t talk about. He once tried to explain to me what it feels like to see your best friend torn in half by a landmine at little more than arm’s reach. Then with that trauma so fresh that there literally wasn’t a minute to process it, he immediately resumed six weeks of marching 12 hours a day through the exact same landscape, wondering if his next step would be the one that tore him to pieces.

Like so many veterans, Dave’s life was never the same after he returned to NZ. All it took was a door to slam shut in the wind, and his entire nervous system would react as if a landmine had gone off next to him. A bang from a car exhaust and he would literally find himself face down on the pavement before his conscious brain could process the moment. 

It’s impossible not to be affected by hearing these experiences directly from the source of that much suffering. After the landmine story, I had to make something up so that Dave thought I had to attend to something in the clinic. Really I had to go out of the room to let out a few quiet sobs that I didn’t want him to see. War is a truly horrifying thing.

When I met him, Daves’s health was about what you might expect after half a century lived with that much trauma stored up in his body. He was also at the sobering stage where the number of attendees in his battalion’s reunions had dropped to single digits. The rest either being dead or far too frail to attend.  

PTSD’s impact on humans is not just about flashbacks, anxiety and depression. PTSD sufferers have far higher rates of cardiovascular disease, digestive tract diseases, obesity, chronic fatigue, addiction and, of course, pain.

Dave himself had diabetes, heart disease, prostate cancer and chronic pain. Of the 5, the chronic pain was the one that bothered him the most. He had 40 years of constant back pain, which crippled him for anything more than a 5-minute walk and 2 hours of sleep per night. And he had been like that for decades. I met him when his orthopaedic specialists finally tapped out after years of failed drug interventions and sent him to me for a second opinion. Surgery had never been an option. Despite being in his 70s with chronic back pain, Dave had less spinal arthritis than most people his age.

Estimates on the percentage of long-term PTSD sufferers who develop chronic pain sit between 30-50%. Stats like these are a loose guide, however. The true number could be much higher. Meanwhile, the prevalence of high-impact chronic pain (like Dave’s) is less than 5% of the general population, depending on which country you look at. So roughly speaking, having PTSD may increase your chances of chronic pain as much as tenfold.

Up to this point, Dave’s and Lucy’s stories are similar in some sense as far as the history of their respective pains went. They both had this chronic disabling pain that wasn’t responding to treatments that usually have a good hit rate. Neither had any medical explanation for their pain despite having been tested and scanned endlessly. Both had a grim prognosis and had been discharged by medicine. And they both had substantial ‘probable cause’ for their pain on a psychosomatic level. Lucy by way of a severely dysfunctional life situation, and Dave by way of chronic PTSD.

But the results treating Dave could not have been more different to those found when treating Lucy.

Despite being more than twice Lucy’s age, and relatively speaking in a very poor state of health, Dave’s pain proved to be extremely easy to treat. After six intensive 1-hour sessions in a month, he went from his 40-year-long 2 hours of sleep per night average to 6 solid hours a night; and from 5-minute walks to 45-minute walks. These results continue to improve and consolidate to this day. He is living a completely different life, and it took a fraction of the effort that one would expect.

The difference between Dave and Lucy’s outcomes reflects a principle that is easily observable among all ‘psychosomatic heavy’ pain sufferers if you treat them in large numbers. Those with clear and present stressors heal very slowly and, in some cases, not at all. While those whose pain relates to past stressors tend to heal much faster than you would expect.

This fact highlights something surprising about pain. It acts as a feedback mechanism; that much is obvious. But it can give feedback on some surprising variables, like career, emotional trauma and relationships.

Pain keeps us safe; when we are doing things that are harmful to us and our health, it lets us know. This is self-evident when it comes to hot stoves and excessive heavy lifting. And it is less self-evident when it comes to jobs we hate and relationships that have turned sour. But it is nonetheless true.

The pain you get when you touch a hot stove tells you to take your hand off the stove. Then the moment you take your hand off the stove, the pain begins to resolve immediately. If you keep your hand on the stove, however, that pain will continue indefinitely. 

Lucy’s pain was being perpetuated by her life situation, and it was therefore impossible to treat; because, figuratively speaking, she still had her ‘hand on the stove’. Dave’s trauma was in his past, and he had processed much of it psychologically with counselling, so his hand had figuratively been taken off the stove.

This plays out every day in pain management clinics and in countless iterations. The person whose last job was stressful heals quickly, while the person whose current job is stressful is very hard to treat. The person with migraines and in a toxic relationship is very hard to treat, then later, when they leave the relationship suddenly, their migraines become easily treatable or even spontaneously resolve. These observations highlight another surprising fact about psychosomatic pain. It is very, very common.

Most psychosomatic pain is not the ‘high impact’ type associated with  PTSD and wildly dysfunctional life situations. Work stress, anxiety, difficult relationships, divorce, finances, bereavement, depression and anxiety disorders can all easily ‘pour kerosene’ on your body’s mechanical issues and make them far more challenging than they would be otherwise. 

We have a better chance of making it through our life without a virus than we do without some trauma or another. This fact may be the single most significant factor in determining the severity of the pandemic we live in the midst of.

Psychosomatic pain exists on a spectrum; most health issues do. Some people might have pain that is 10% psychosomatic and 90% mechanical. At the other extreme end of the spectrum are those with pain that is 90% psychosomatic and 10% mechanical. And it can be surprising how many chronic pain sufferers occupy the psychosomatic end of the spectrum.

A large study funded by Boeing into the causes of chronic back pain among its workers found something surprising. And what they found speaks volumes about the true nature of chronic pain. When all was said and done, it wasn’t heavy lifting that predicted back pain, nor was it workplace accidents or a lack of core strength. 

The workers who experienced the most back pain were those who felt unappreciated by their line managers. This factor was the only variable that emerged as a reliable predictor of significant back pain. Across a large cross-section of workers

Yet all psychosomatic pain sufferers do have physical issues. Lucy had flat feet, loss of muscle tone and very inflamed muscles. Dave had a great deal of scar tissue and inflammation in his lower back. Their pain was driven and fuelled by their central nervous systems, but it was ‘speaking to’ genuine physical dysfunction. This is easiest to understand when compared with a gut issue like irritable bowel syndrome.

Universally sufferers of irritable bowel syndrome struggle terribly when they are impacted by stress. But this doesn’t mean that there is not an issue with their gut microbiome. Their symptoms are caused by a combination of stress and a dysregulated microbiome. Similarly, pain sufferers symptoms are caused by a combination of stress and dysfunction in the musculoskeletal system.

In some mysterious way, fight or flight activity has the ability to activate symptoms in weakened body systems. If you have an imbalance in your gut from antibiotics and a poor diet, that’s where your stress and trauma will manifest. If you have a weakness in your core, your trauma will turn into back pain. If you have an old whiplash injury in your neck, work stress will tend to translate into neck pain and headaches. If you have skin issues, stress will tend to flare psoriasis or eczema. And so on. 

Like so many natural phenomena, no one really knows how all this works.

We don’t know the first thing about how salmon traverse oceans and find their way back to their own little river, yet they definitely do. Nature has complex ways. Yet her patterns are often easy enough to observe. And the manifestation of mental and emotional issues within the body’s cells is one such pattern. This is the truthful yet mysterious truth behind psychosomatic pain. 

Understanding psychosomatic pain as a feedback mechanism offers the sufferer a golden healing opportunity. If you know your pain is most likely a combination of mechanical issues and some ongoing or unresolved emotional stressor, you have a golden ticket to begin uncovering the issues and work to resolve them. It might not be easy work, but it’s a quantum leap from thinking you are broken; or that your pain is a mysterious disease. Resolving psychosomatic pain requires work. And a deep acceptance that pain itself is not a disease or condition; it is a symptom.

A sneeze is not an illness; it’s a symptom of illness. Vomiting is unpleasant, but it is your body’s way of preventing poisoning. A cough is the body’s way of clearing the airways. And pain is the body’s way of keeping us from harm. If the body spoke languages, the pain would be one.

The key to successful treatment of psychosomatic pain is to work on the whole person. The secret sauce in those intensive sessions that got Dave, the war veteran, sleeping and walking within a month was their holistic nature. The tissue-based portion of the treatments cleared inflammation from his spinal soft tissues and broke up old tracks of scar tissue. While the ‘brain-based’ portion involved  ‘brainwave entrainment‘ (high-frequency light therapy) and was used to switch off the persistent fight or flight activity in his brain’s limbic system.  

In Lucy’s case, none of that worked because her pain was made of something different. But when she finds ways to make the necessary changes to her underlying problems, her pain will resolve too. Sadly for her doing that involves some hard decisions about where,  how and with whom she lives her life.